| Abstract [eng] |
Acute ischemic stroke is one of the leading causes of mortality and both early and long-term disability worldwide. Over the past decades, significant advances in reperfusion therapies – intravenous thrombolysis and mechanical thrombectomy – have enabled the effective restoration of cerebral blood flow and the mitigation of stroke-related consequences. However, the clinical success of these interventions depend not only on time-to-treatment and the patient‘s clinical condition but also on the individual anatomic characteristics of cerebral vasculature. An increasing number of studies emphasize the critical influence of anatomical variants of the Circle of Willis on stroke progression, infarct size, and clinical outcomes. The aim of this study was to assess the significance of cerebral vascular anatomical features in the course, treatment, and outcomes of acute ischemic stroke. To achieve this, the following objectives were established: (1) to review the clinical presentation of acute ischemic stroke, its main factors, and current treatment strategies; (2) to identify fundamental anatomical variants of cerebral vasculature, with particular focus on the structure of the Circle of Willis, and evaluate their prevalence and clinical relevance; (3) to analyze recent scientific data regarding the impact of specific vascular anatomical features on stroke development, the extent of brain tissue damage, and treatment outcomes. An extensive analysis of up-to-date scientific literature was conducted to explore the potential relationship between vascular morphological variants, the effectiveness of collateral circulation, and the success of reperfusion therapy. The findings revealed that an incomplete Circle of Willis – such as hypoplasia or aplasia of the anterior communicating artery or the A1 segment of the anterior cerebral artery—significantly reduces the efficiency of collateral circulation, particularly in cases of anterior circulation occlusion. These anatomical features are associated with larger infarct volumes, more severe neurological deficits, and a lower likelihood of achieving favorable functional outcomes at three months. In contrast, well-developed collateral circulation is correlated with a lower risk of hemorrhagic transformation, faster regression of neurological symptoms, and more favorable long-term outcomes following either thrombolysis or thrombectomy. The clinical course and outcomes of acute ischemic stroke are closely linked to the patient’s individual vascular anatomy. Variants of the Circle of Willis that influence collateral flow may serve as important prognostic markers and should be considered during clinical decision-making to better predict treatment outcomes and tailor therapeutic strategies. |
